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Arunachal: Comprehensive research work to be undertaken to unearth rising prevalence of cancer in AP

ZIRO- A comprehensive research study to find out the causes of rising stomach cancer in Arunachal Pradesh and Ziro Valley in particular will be jointly undertaken by State Cancer Society of Arunachal Pradesh in collaboration with Dr. B. Borooah Cancer Institute Guwahati, NIPER Guwahati, IIT Guwahati, RGU and TCC TRIHMS.

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This was the outcome of the meeting held today at official chamber of Lower Subansiri Deputy Commissioner Vivek HP and other stakeholders.

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The meeting was attended by Dr. Ashok Kr. Das, Professor Head and Neck Oncology, Dr. B. Borooah Cancer Institute Guwahati, Dr. Abhijit Talukdar, Associate Professor and Head Surgical Oncology, BBCI Guwahati, Dr. M. Asghar, Prof & Head Anthropology Department, RGU, Dr. Hage Sonia and Dr. Rubu Sunku, Radiation Oncologists of Tertiary Cancer Centre, TRIHMS.

The meeting is a follow up of the Cancer Screening and Awareness Camp held from 6 to 8 October last year at Ziro by State Cancer Society of Arunachal Pradesh under the supervision of the then Special Secretary Health Vivek HP and the concept and idea to take up the etiological study was suggested by him during the said camp.

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Dr. Ashok Kr. Das, Professor Head and Neck Oncology, Dr. B. Borooah Cancer Institute Guwahati informed that the incidence of gastric cancer is very high in Arunachal Pradesh particularly in Ziro Plateau. The cause of this high incidence is unknown, but it is presumed that multiple factors notably dietary factors, prevalence of pathogens in the stomach, tobacco use, presence of heavy metals in food and water besides genetic causes are responsible for the high incidence of the disease.

Dr. Das also explained that the interplay of these risk factors aggravates the situation. ‘In order to formulate effective intervention strategies, it is imperative to understand the prevalence of these risk factors, the cumulative exposure of individuals, and the community to these risk factors, and the stage by stage change caused by these risk factors which ultimately lead to malignant transformation of the gastric mucosa. With this knowledge, it will be possible to formulate appropriate intervention strategies to mitigate this risk’, he informed.

 Explaining the modus operandi of the upcoming research work, Dr. Das informed the research proposal aims to integrate community participation in implementing the program at every step. ‘It will be conducted within predefined geographic boundary of a few target villages in Ziro Valley from which the highest number of gastric cancers have been reported, and attempt to involve the whole population aged between 20 to 65 years within these boundaries’.

‘The concept and plan will be conveyed to people through multiple group meetings and discussions involving civic bodies and district administration. ‘The entire process will be clearly explained to the participants and their concerns will also be addressed. Only the informed voluntary participation will be accepted and the findings from the ongoing study will be ethically shared without reservations with the community at every step’, he explained.

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Dr. Das further explained that the methodology adopted will be a cross-sectional study of the population followed by a longitudinal study to identify the effect of interventions, and also to monitor people under high risk.

‘In the first phase, participants will be screened using endoscopy and mucosal biopsy for histopathology and microbial study (BBCI and TCC TRIHMS). Approximately 100 such screening camps will be conducted over 36 months of the project covering 6000 to 10000 people. In parallel, food habits will be recorded to assess food frequency exposure (by RGU). Different food items and water will be sampled and analyzed at NIPER Guwahati for carcinogens’.

‘After collating data and statistical analysis to derive cause consequence relationships, probable intervention strategies will be devised and shared with the community for adoption’ (All Institutes and State Administration).

‘During the second phase, the quality and extent of adoption will be monitored, and individuals at high risk (approximate number anticipated to be 200-300) will be followed up clinically with periodic yearly endoscopy’ (State Cancer Society and TRIHMS).

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‘If found to be successful, these interventions will result in gradual decrease in gastric cancers which will be fully evident and stable in twenty years. It is also expected that many of the same factors are responsible for the high gastric cancer incidences in rest of Arunachal Pradesh, and the same interventions will be effective in bringing down this number’.

‘The tentative cost of the research work is Rs 450 Lakhs spread over 36 months which includes two video-endoscopy units for Gyati Takka General Hospital, Ziro. The proposal under preparation will be submitted to ICMR for consideration’, informed Dr.Das.

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